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DEPARTMENT OF HEALTH SERVICES Division of Public Health STATE OF WISCONSIN (608) 267-9003 Botulism Testing Request Screening Worksheet Patient Information Patient's Name (Last) Patient's Address County
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How to fill out botulism testing request
How to fill out botulism testing request:
01
Start by gathering all relevant information such as your personal details, including name, address, and contact information.
02
Proceed with providing details about the sample being tested, including the type of product, its brand name, batch number, and expiration date.
03
Next, describe any symptoms or reactions experienced after consuming the product, if applicable.
04
Include information about where the product was purchased, including the store name and location.
05
Specify the date of purchase and provide any additional relevant details about the product or incident.
06
If you have any supporting documentation such as receipts or packaging, make sure to attach copies to the testing request.
07
Finally, sign and date the request form.
Who needs botulism testing request?
01
Individuals who have consumed a product and experienced symptoms or reactions commonly associated with botulism poisoning.
02
Anyone who suspects that a particular food or product may be contaminated with botulism toxin.
03
Healthcare professionals who are treating patients with suspected botulism and need to confirm the diagnosis through laboratory testing.
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What is botulism testing request?
A botulism testing request is a formal request to conduct testing for the presence of the botulism toxin in a sample.
Who is required to file botulism testing request?
Any individual, organization, or establishment that suspects the presence of botulism toxin in a sample is required to file a botulism testing request.
How to fill out botulism testing request?
To fill out a botulism testing request, you need to provide your personal or organizational information, details about the sample to be tested, and any relevant symptoms or observations.
What is the purpose of botulism testing request?
The purpose of a botulism testing request is to determine whether a sample contains the botulism toxin, which can be useful for diagnosing and preventing botulism poisoning.
What information must be reported on botulism testing request?
On a botulism testing request, you must report your contact information, sample details, and any relevant symptoms or observations.
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